“While I acknowledge your perspective … I must advise you that there are no plans to amend the Act to man-date jurisdictions to negotiate agreements that include dispute mechanisms with medical associations ... Moreover, the provision does not oblige a province to use a particular approach to negotiate remuneration.”

That was the April, 2013 response by then federal health minister Leona Aglukkaq to a request by Dr. Anna Reid, then president of the Canadian Medical Association, asking for mandatory binding arbitration to be incorporated into the Canada Health Act (CHA).

For example, in June, 2012, omnibus Bill C-38 cancelled the exclusion of RCMP members as “insured persons” under the act.

As a spokesman for then public safety minister Vic Toews put it at the time: “We are upgrading their status so they can receive the same high standard of health care as any other Canadian. This will save the federal government $25 million per year … and will not impact the budgets of the provinces.”

RCMP members started being covered by their provincial health insurance plans a year later.

It is difficult to understand this “new math” where provinces are told to take over RCMP health care costs, yet not incur any new expenses.

This is similar to the present situation with Syrian refugees.

Unless things change, provincial health ministries will be told to take over these expenses with no corresponding increase in federal transfer payments.

In Ontario, these costs will ultimately be downloaded to physicians and hospitals.

Even if provincial transfers were increased, it’s unlikely physicians or hospitals would see the funds.

Although the Canada Health Transfer was recently increased by 6%, the Ontario health care budget rose by only 1.2%.

According to Ben Eisen of the Fraser Institute, in the past 10 years, major federal transfers to Ontario increased by 87.8% and inflation-adjusted per person transfers rose by 43.4% — both the second largest increases in Canada.

The Ontario Medical Association has launched a Charter challenge in the hope of winning binding arbitration in its negotiations with the government, a mechanism that already exists in eight other provinces and territories.

They cannot opt out or set their own fees. Their medical ethics preclude striking to get what they want.

Prior to the recent unilateral cuts, they had agreed to a freeze in fees, but not dras-tic cuts and not a hard cap on expenditures, regardless of population growth and an aging population needing more care, to say nothing of possible future pandemics.

The stalemate continues. Although Hoskins reassures the public nothing will change, many younger, mobile doctors may leave the province, older physicians may retire prematurely, certain clinics may close and patient access to timely, quality care will likely suffer and deteriorate.

Philpott, the new federal health minister, should take the initiative to resolve this impasse.

After Parliament resumes Jan. 25, she should begin the process of amending the CHA to make binding arbitration mandatory if negotiations fail, along the lines already suggested by the Canadian Medical Association.

— Shaver is chair of the Ontario medical association section on general internal medicine